Provider Demographics
NPI:1285790337
Name:HAGEMANN, ANDREA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RUTH
Last Name:HAGEMANN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3181
Mailing Address - Fax:314-362-2893
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV OBGYN GYNECOLOGIC ONCOLOGY, STE 13C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3181
Practice Address - Fax:314-362-2893
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005770207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205598303Medicaid
MO1285790337Medicaid